Sever Aviv, Rabinowicz Ron, Barzilai-Birenboim Shlomit, Fisher Salvador, Levi Ronit Goldman, Yanir Assaf, Stein Jerry, Bilavsky Efraim, Yacobovich Joanne, Yahalom Vered
Department of Pediatric Hematology/Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.
Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Pediatr Blood Cancer. 2025 Nov;72(11):e31979. doi: 10.1002/pbc.31979. Epub 2025 Aug 11.
Granulocyte transfusions (GTXs) are used in neutropenic pediatric hemato-oncology patients with infections unresponsive to antimicrobial therapy, but their clinical benefit remains uncertain.
We retrospectively reviewed all pediatric patients who received GTXs between 2013 and 2023 at a tertiary medical center. We assessed associations between GTX administration, absolute neutrophil count (ANC) increment, and C-reactive protein (CRP) reduction as a surrogate marker of treatment response.
Forty-nine patients received 312 GTXs across 56 episodes: 47 for therapeutic use during active infection and nine for secondary prophylaxis. Higher ANC increments were observed after transfusions containing ≥0.6 × 10⁹ neutrophils/kg from same-day collections. ANC rises were transient, typically declining within 24 hours. CRP levels decreased significantly after the first GTX (p = 0.001) and more markedly by the end of treatment (p < 0.001). ANC increment was significantly associated with CRP reduction (p = 0.006). GTX-related adverse events occurred in 3% of transfusions. Infection-related mortality was 17% in the treatment group, while no severe infections occurred in the secondary prophylaxis group.
GTXs appear to be a safe adjunctive therapy in high-risk neutropenic children with severe infections. The observed correlation between ANC increment and CRP reduction supports a potential therapeutic effect and warrants further prospective evaluation.
粒细胞输注（GTXs）用于对抗菌治疗无反应的中性粒细胞减少的儿科血液肿瘤患者，但它们的临床益处仍不确定。
我们回顾性分析了2013年至2023年在一家三级医疗中心接受GTXs的所有儿科患者。我们评估了GTX给药、绝对中性粒细胞计数（ANC）增加和作为治疗反应替代指标的C反应蛋白（CRP）降低之间的关联。
49名患者在56个疗程中接受了312次GTXs：47次用于活动性感染期间的治疗，9次用于二级预防。从当日采集的粒细胞中输注≥0.6×10⁹个中性粒细胞/kg后，观察到更高的ANC增加。ANC升高是短暂的，通常在24小时内下降。首次GTX后CRP水平显著降低（p = 0.001），治疗结束时更明显（p < 0.001）。ANC增加与CRP降低显著相关（p = 0.006）。3%的输注发生了与GTX相关的不良事件。治疗组的感染相关死亡率为17%，而二级预防组未发生严重感染。
GTXs似乎是患有严重感染的高危中性粒细胞减少儿童的一种安全辅助治疗方法。观察到的ANC增加与CRP降低之间的相关性支持了潜在的治疗效果，值得进一步进行前瞻性评估。
